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Published on: December 17, 2014
Brain perfusion SPECT imaging and acetazolamide challenge in vascular cognitive impairment
Karim Farid1, Slavomir Petras, Valérie Ducasse
1Nuclear Medicine Department, AP-HP, Hôtel Dieu Hospital, Paris, France. kwfarid@hotmail.com
Insights
Vascular cognitive impairment (VCI) is linked to cerebrovascular disease and cardiovascular risk factors. Brain perfusion SPECT imaging may offer vital functional insights for early VCI diagnosis and management.
Area of Science:
- Neurology
- Radiology
- Gerontology
Background:
- Cerebrovascular disease is a primary cause of cognitive impairment and dementia, often co-occurring with Alzheimer's disease.
- Vascular cognitive impairment (VCI) encompasses heterogeneous disorders stemming from cerebral vessel disease, with age and cardiovascular risk factors being key contributors.
- Preventing and delaying VCI through risk factor management is crucial, though only hypertension treatment is currently established for vascular dementia prevention.
Purpose of the Study:
- To review the utility of brain perfusion single-photon computed tomography (SPECT) in investigating VCI.
- To explore the potential of scintigraphic quantification of cerebral hemodynamic reserves for VCI assessment.
- To highlight the underutilization of functional imaging in VCI diagnosis compared to morphological methods like MRI.
Main Methods:
- Review of current literature on VCI, cerebrovascular disease, and diagnostic imaging techniques.
- Discussion of brain perfusion SPECT, including its use in baseline conditions and after acetazolamide challenge.
- Analysis of the limitations of morphological imaging (e.g., MRI) in providing functional information for VCI.
Main Results:
- Brain MRI, while standard for vascular pathologies, lacks functional insights crucial for VCI.
- Brain perfusion SPECT offers valuable functional information and may quantify cerebral hemodynamic reserves.
- Current VCI screening strategies lack standardization, necessitating further research for early diagnostic protocols.
Conclusions:
- Brain perfusion SPECT is an underutilized but potentially valuable tool for VCI investigation.
- Quantification of cerebral hemodynamic reserves using scintigraphy could enhance VCI diagnosis.
- Standardized, long-term imaging studies are needed to establish reliable early diagnostic protocols for VCI.
Abstract:
Cerebrovascular disease is recognized as a common cause of cognitive impairment and dementia, alone or coexisting with other neurodegenerative diseases, mostly Alzheimer's disease. Vascular cognitive impairment (VCI) is a part of the heterogenous disorders group related to cerebral vessel disease. Although age is one of the most important risk factors for VCI, other common cardiovascular risk factors are also involved. By investigating these risk factors, a high proportion of these cognitive disorders can be prevented and/or delayed. Until now, only treatment of midlife arterial hypertension has been recognized as a preventing factor of vascular dementia. Brain MRI is becoming the method of choice to investigate cerebral vascular pathologies. However, this form of morphological imaging remains inadequate and does not provide useful functional information during VCI exploration, despite which functional imaging such as brain perfusion single-photon computed tomography, performed in baseline conditions and/or after an acetazolamide challenge, is underutilized in VCI exploration. The common strategies for VCI screening have not been standardized until now, and therefore further long-term imaging studies are needed to establish early diagnostic protocols. The present review summarizes the potential benefits of brain perfusion single-photon computed tomography imaging and possible scintigraphic quantification of cerebral hemodynamic reserves in investigation of VCI.
